.Most Caucasian (fair-skinned) people are not suited to live near the equator. They tend to develop skin cancers more frequently than their ancestors who lived farther to the north. Whether or not people develop precancers, wrinkling, freckles or cancer is dependent upon two things: the environment (how much sun time) and genes (ancestors all the way back). Sunscreens definitely limit certain kinds of sun damage and are worthwhile as long as we keep a few important things in mind. An attempt will be made to set straight some of the recent rumors about sunscreens in this section. See Sun Protection.

Sun sensitivity has much to do with skin type. Several systems of typing the skin have been devised. The following is a five-point scale in which the lower the skin-type number, the more susceptible one is to sun damage.

Sunburns are painful. If you are going to be outside on a day that is not densely overcast, it is a good idea to put sunscreen on as much exposed skin as possible. Why? Most shirt material has a sun protection factor (SPF) of only three to six. That means if you are out for three to six hours, covered with shirt material, you will get one hour of burning rays. These rays mutate your skin cells' genes, perhaps permanently damaging them. If you do not like painful burns, this is certainly a reason to wear sunscreen. It is better to be naked at the beach and have fully applied a number 15 SPF sunscreen than to be fully clothed in T-shirt material with no sunscreen.

Why do some people burn on a cloudy day? Sometimes the cloud formations are just right to scatter, reflect, re-reflect and focus the sun's rays on the surface of the earth, where we all hang out. Extra radiation means extra damage to your skin and a need for even more sun protection than usual.

"I don't go in the sun," say some wrinkly, spotted patients. Let's define "go." How many minutes do you spend in the direct sunlight each day? How many minutes in the shade by the pool, with the ultraviolet radiation bouncing off the water and surrounding buildings and concrete? Fifteen minutes of sun a day in Florida adds up to 60 hours a year, and in Florida, we do not have time off in the winter for "dark repair, gene repair" to take place. Spending time in the sun is all relative to the amount of time spent, quality of protection and, most importantly, your genetic background.

Mixing sunscreens is not usually a problem, nor is using one sunscreen on one part of the body and another brand on another part of the body. The author frequently will use a particular type of sunscreen on the face and another brand on the rest of the body. A creamy or oily lotion to provide greasing for dry skin in dry conditions might be better for winter in the desert. A clear alcohol-based gel or clear solution might be preferable for young people with oily facial skin. One type for the face that works in many conditions is Coppertone Sport™ SPF 15 or greater.

Sunscreens are composed of many different ingredients, including dozens of perfume chemicals. Patients may be or become allergic to one or more of these. Patch testing is usually unnecessary and an unproductive spending of money. Most patients can solve the problem by switching to another brand of sunscreen without needless testing.

Having Parasol™ in a sunscreen is likely helpful, but the jury is still out on just how damaging UVA rays can be. Some estimates indicate that UVA rays are 15% "as much cancer causing" as UVB rays. It may be that UVA has to act in concert with UVB damage to make matters worse. If the latter were true then just blocking UVB would be all that was needed.

Parasol, in the form of Parsol 1789 has been around for a decade in the form of Shade UVA Guard™ and Photoplex™ sunscreen brands which were both a bit thick and greasy. The FDA even prohibited manufacturing new sunscreens with Parsol for a while because of some reports of serious allergic reactions. It appears that the combination of Parsol and cinnamates (other popular sunscreen ingredients) caused the reactions. Parsol now comes in better feeling sunscreens like Ombrelle brand that even has a spray form. Parasol is just like any other new sunscreen additive or cosmetic or magic youth cream. Every year manufacturers come up with something newer and a bit better. The popular press goes wild. There is a media frenzy. Then millions use it, reality sets in and everything calms down. In another year manufacturers will "discover" another good compound. For now, Parsol will be the temporary rage of the years 1998 and 1999.

Every year concerned patients should consider going out before the big sun season, for example May in the Northern Hemisphere, and buying some of the newer sunscreen brands. If a patient doesn't like using the sunscreen they have chosen, then it's likely less will be applied. Sunscreens do not work well inside the bottle. Find something you do like and use it. Companies are constantly changing and upgrading their products, so look for what's new in sunscreens. But be careful when you look for the newest information. Here is why.

Studies and reports of sunscreen wisdom are many times outdated, wrong or incorrectly performed. First, let's talk about outdated. You have probably heard from friends regarding SPF (sun protection factors in sunscreens) that "dermatologists have shown that anything over 15 does not matter or help." Your friends are likely outdated, but more recent studies need to be done to correct them. Your friends' information came from dermatologists in the late 1980's. Chemicals change, vehicles (other carrying ingredients in the sunscreen) change, times change. Until new studies are available, the website author tells his patients with melanoma and severely atypical moles to use between 35 and 50 SPF. 35-50 SPF sunscreens are not toxic and certainly do last longer at the beach. Patients easily can test their ability to reduce sunburn within one day. Put a 15 on the left side of your body at 9am and reapply the 15 on the left side at noon. Put a 45 SPF on the right side of the body only at 9am. Just one application of the 45 wins in most people and the 45 does not cost even twice as much as the 15. Use common sense. Old information needs to be constantly challenged and questioned if humanity is to advance. Before the Wright Brothers, many scientists openly laughed at the possibility of human flight. One (especially scientists) should never be too sure. Now let us next discuss a flawed study.

In 1997, a study (by Dr. Berwick of Memorial Sloan-Kettering Cancer Center) was published regarding melanoma and sunscreens. The study "showed", as some in the press represented, "that sunscreens do not stop skin cancer." What may have occurred in the study. The study "showed" that one type of cancer, melanoma, might not prevented by sunscreen, and may even be made worse, according to other news releases. Before we discuss it further, I hope the audience is thinking about whether the Berwick study was a good study or was it flawed before even thinking seriously about the conclusions. It could be however that the results of the study are indeed correct. If so, that may suggest that current and past sunscreens may be toxic to or may mutate the melanocytes causing melanoma. This seems unlikely, however, scientific testing and studies should be done for a better understanding.

Sunscreens absorb only certain light rays of certain wavelengths, each of certain strength. Possibly some bad solar rays were not absorbed (blocked) by the weaker types of sunscreen used by the patients studied. How old were the sunscreens? What were their principle sun-blocking chemicals? Were there any other factors to cause the study patients to get more melanoma? Were they richer, spending more time traveling in the sun and being examined by "better" doctors? Could another part of the problem have been in these study patients who used the sunscreens that they thought they were protected, and so spend more time in the sun, allowing the less-filtered rays that could cause melanoma to penetrate their type of sunscreen. Maybe the story would have been different if the patients in the study used newer (broad spectrum UVA and UVB) sunscreens properly. The word properly is important because in the website author's experience at least one-quarter to one-half of patients apply sunscreen improperly. Improperly in sunscreen language means too thin, wrong kind, didn't reapply after sweating or bathing, or missed areas altogether. Too many people don't apply sunscreen under a thin shirt or hat. They mistakenly think wearing the shirt or hat automatically protects them. That is wrong and a habit like that can mess up a study and cost a life.

Let us return to and briefly describe the Berwick study. In February 1998, Dr. Marianne Berwick from the Memorial Sloan-Kettering Cancer Center published her findings. These findings sent shocks through the dermatology world. After the popular press got through "translating" the story into eye-catching headlines and SoundBits, Americans were left wondering whether they were wasting their time with sunscreens or whether sunscreens made melanoma worse. Certainly, the name of Sloan-Kettering is reputable. So the study must be true, right? No, not necessarily. Please read Cancer Studies, What to Make of Them after reading this chapter if you have not already. Remember that the study may have drawn the right conclusion, but that conclusion depends on how the study was set up? Dr. Berwick is quite bright, but to set up the right study to draw the right conclusions costs money and time. This is especially true since the best studies test patients and ideas PROspectively, meaning in the future, not looking back to data from the past. PROspective studies take years to do and cost big bucks. Dr. Berwick did the best with what she had. However, the website author thinks that what she had was not enough and that Dr. Berwick should have criticized her own study more before releasing the information.

Many times good doctors and scientists do good work, and are very specific, word-for-word about their findings. Then the press, and you can not really blame them because they are not medical specialists, gets a hold of it. The reporters and writers are pressured by their newspaper or TV management to get the public's attention. The reporters in the press have to wear many hats and it is impossible to be an expert at everything. Even a doctor/researcher who does a great study and gets the right findings and results in a medical journal can end up with a story that even the doctor/researcher does not recognize or agree with when it comes out in a public newspaper! It is sad but it can happen.

Since Dr. Berwick did not criticize her own study well enough, the website author will do it for her. Sorry Marianne! To begin with, the study was retrospective (looking back). The Berwick study was done by asking patients about their past (retrospective) habits. Did Berwick ask exactly what brands of sunscreen were applied? Most of the sunscreens applied were low SPF 10 or 15. Nowadays, most dermatologists recommend 15 or over. Did Berwick ask how many times the study group subjects missed applying sunscreens? How did they apply them? They could not have been taught since the Berwick study was retrospective. Was the study controlled for geographic location in the US? Was this a proper and paired comparison? What kind of patients made up the study? Was the study biased because it contained many fair skinned patients, who have a higher risk for melanoma than the general public? There was little control in this study to check these criticisms. A prospective (forward-looking) study needs to be done. The flaws of the Berwick study should be used to especially focus control on the criticized variables. This way we can make use of potentially flawed Berwick study and move forward.

Interestingly, Berwick's conclusions could still be right. In the past many flawed, poor studies have given the right answer, it is just the element of chance. Remember, just because a study comes out of a reputable institution like Sloan-Kettering does not mean that it is correct or correctly done. I believe it is now Sloan-Kettering's responsibility to pay for and to make a new study to confirm their last one. Amusingly, the website author's last suggestion may introduce bias because he just put egg on Sloan-Kettering's face. Sloan-Kettering may then try to design a study to prove their point rather than one that addresses the underlying question of whether or not present day sunscreens reduce melanoma. Think of how hard it is to do a forward-looking study here since you would be handing patients this year's sunscreens. By the time the study is done they may be last year's sunscreens. Melanomas in humans don't develop overnight. It would take years to do a good study.

It is hoped that the results of the Berwick study will not cause many people to not use sunscreen, because as the website author states, sunscreens definitely help against basal and squamous cell cancer. It is hoped that a new study using the newest and best sunscreens will be done PROspectively and that results will be available in 3 to 5 years. Why? Because some (probably not many, but some) people are reducing or quitting sunscreen application as a result of the media buzz following the Berwick/Sloan-Kettering study. As a result people will likely die. Sadly, it is possible for bad science to hurt people, even when it has a good label on it.

After all of the hullabaloo, Dr. Berwick finally stated "people who have a genetic predisposition to melanoma should understand their risk, avoid sun exposure, and not have a false sense of security if they use sunscreen." Too late Marianne, the popular press and public may not be listening now.

To modify a famous quote "There are lies, damned lies and statistics." Put the word "studies" in place of "statistics" since most published medical studies must discuss how they arrived at their statistics and are therefore founded on them. People, politicians and scientists can easily manipulate criteria in studies to modify their statistics, it happens most often. Only a trained eye usually will read the whole study, most doctors just read the superficial capsule at the beginning of the study then file/throw away the journal.

Sunscreens not only reduce sunburns, but the author knows from decades of patient care that sunscreens also definitely reduce precancers of the squamous type and they definitely reduce basal and squamous-cell cancers. No wonder these patients felt protected. They could see the results for themselves, less cancers and better-looking skin. Even if Dr. Berwick is right, there is no reason to abandon sunscreens just because they might be ineffective against melanoma, a cancer that affects only 1 in 100 to 125 Americans. Sunscreens certainly work against other cancers, as well as prevent painful sunburns. However, Americans who are susceptible to, or at risk, of melanoma should be concerned about the results of this study. Unfortunately, patients with dysplastic or atypical moles or a family history of melanoma must, to be on the safe side, take the results of this study seriously, and avoid direct or indirect sun as much as possible. Hopefully, the findings of the Berwick-Sloan-Kettering sunscreen-melanoma study will be re-tested. Possibly newer studies (it will probably be a couple of years) will tell us that newer broad-spectrum sunscreens will reduce the chances of melanoma. Until then, melanoma and atypical mole patients may be stuck with the findings of the Berwick study. After all it could be right, we study things with good science and get surprised all the time. Whether or not the Berwick study is confirmed, there should be absolutely NO reading of books (idle non-sporting, non-cardiovascular) activities or gardening in the sun. Active sports in the morning and evening sun are acceptable.

Americans who are susceptible to melanoma are discussed in the melanoma section of this website. Please see melanoma and atypical mole chapters for more information. For our purposes, melanoma-susceptible Americans are ones with any family or personal history of melanoma or dysplastic nevi (moles).

Just using sunscreen may sometimes not be enough. If the reader wishes to protect him/herself from UVB, the most dangerous of the ultraviolet waves reaching the earth's surface, then the following options exist:

1. Glass and some forms of plastic glazing materials "screen" UVB.
2. Wear protective clothing. Fabric should be of a tight weave. T-shirts offer little protection and have a SPF of about 6. Special UV clothes are available.
3. Use sunscreen with a SPF of at least 15. Apply at least 15 minutes before sun exposure. Use it year 'round - remember that clouds screen out only 20% of the UVB!
4. Stay out of the sun between the hours of 10:00 a.m. and 3:00 p.m. Sunglasses will screen most UVB because they are glass or plastic. Choose a wrap-around style or a pair with side shields.